Provider First Line Business Practice Location Address:
4122 WEBER RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-884-4299
Provider Business Practice Location Address Fax Number:
361-887-7367
Provider Enumeration Date:
05/08/2006