Provider First Line Business Practice Location Address:
1521 S STAPLES ST
Provider Second Line Business Practice Location Address:
SUITE 203
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-887-9000
Provider Business Practice Location Address Fax Number:
361-887-9010
Provider Enumeration Date:
04/20/2007