Provider First Line Business Practice Location Address:
221 E. WISCONSIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-383-5527
Provider Business Practice Location Address Fax Number:
956-383-4592
Provider Enumeration Date:
11/28/2005