Provider First Line Business Practice Location Address:
3636 S ALAMEDA ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-853-2151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006