Provider First Line Business Practice Location Address:
5945 MCARDLE RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78412-3490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-992-9430
Provider Business Practice Location Address Fax Number:
361-992-9438
Provider Enumeration Date:
08/30/2006