Provider First Line Business Practice Location Address:
1224 3RD ST
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-883-6998
Provider Business Practice Location Address Fax Number:
361-883-1846
Provider Enumeration Date:
06/21/2005