Provider First Line Business Practice Location Address:
4833 S STAPLES ST
Provider Second Line Business Practice Location Address:
STE. 1
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-225-2271
Provider Business Practice Location Address Fax Number:
361-225-2273
Provider Enumeration Date:
02/05/2007