Provider First Line Business Practice Location Address:
7406 UP RIVER ROAD
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:
78409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-289-2890
Provider Business Practice Location Address Fax Number:
361-289-6329
Provider Enumeration Date:
02/13/2007