Provider First Line Business Practice Location Address:
4110 KOSTORYZ RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78415-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-814-0505
Provider Business Practice Location Address Fax Number:
361-854-2879
Provider Enumeration Date:
12/20/2006