Provider First Line Business Practice Location Address:
5530 LIPES
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78413-5511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-993-9494
Provider Business Practice Location Address Fax Number:
361-993-4477
Provider Enumeration Date:
02/13/2007