Provider First Line Business Practice Location Address:
5488 S. PADRE ISLAND DR.
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:
78411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-994-1159
Provider Business Practice Location Address Fax Number:
361-994-1159
Provider Enumeration Date:
10/13/2006