Provider First Line Business Practice Location Address:
1227 3RD ST
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:
78404-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-883-4323
Provider Business Practice Location Address Fax Number:
361-883-4324
Provider Enumeration Date:
11/17/2005