Provider First Line Business Practice Location Address:
6500 SOUTH PADRE ISLAND DRIVE
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78412-4055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-993-2288
Provider Business Practice Location Address Fax Number:
361-993-1199
Provider Enumeration Date:
11/15/2006