Provider First Line Business Practice Location Address:
3933 UP RIVER RD
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:
78408-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-882-1001
Provider Business Practice Location Address Fax Number:
361-882-1040
Provider Enumeration Date:
07/12/2005