Provider First Line Business Practice Location Address:
1701 MORGAN AVE
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:
78404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-883-2273
Provider Business Practice Location Address Fax Number:
361-883-2273
Provider Enumeration Date:
06/25/2007