Provider First Line Business Practice Location Address:
1907 LUBBOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-536-0996
Provider Business Practice Location Address Fax Number:
956-423-3266
Provider Enumeration Date:
05/31/2006