Provider First Line Business Practice Location Address:
3138 S ALAMEDA ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-884-4131
Provider Business Practice Location Address Fax Number:
361-884-4171
Provider Enumeration Date:
06/15/2005