Provider First Line Business Practice Location Address:
5446 LIPES BLVD STE 101
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:
78413-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-992-5655
Provider Business Practice Location Address Fax Number:
361-992-0665
Provider Enumeration Date:
07/02/2005