Provider First Line Business Practice Location Address:
4242 SOUTH ALAMEDA
Provider Second Line Business Practice Location Address:
SUITE #18
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78412-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-985-9000
Provider Business Practice Location Address Fax Number:
361-985-9002
Provider Enumeration Date:
01/25/2017