Provider First Line Business Practice Location Address:
4449 S ALAMEDA 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:
78412-2464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-991-5652
Provider Business Practice Location Address Fax Number:
361-991-5653
Provider Enumeration Date:
03/13/2012