Provider First Line Business Practice Location Address:
7121 SPID
Provider Second Line Business Practice Location Address:
SUITE 302
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-851-5000
Provider Business Practice Location Address Fax Number:
361-851-0590
Provider Enumeration Date:
02/16/2006