Provider First Line Business Practice Location Address:
5501 S EXPRESSWAY 77
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:
78550-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-985-1221
Provider Business Practice Location Address Fax Number:
361-985-1295
Provider Enumeration Date:
08/13/2007