Provider First Line Business Practice Location Address:
830 ORIOLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78418-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-728-7779
Provider Business Practice Location Address Fax Number:
361-993-9809
Provider Enumeration Date:
04/22/2009