Provider First Line Business Practice Location Address:
4122 WEBER
Provider Second Line Business Practice Location Address:
SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-857-6200
Provider Business Practice Location Address Fax Number:
361-857-6201
Provider Enumeration Date:
07/24/2007