Provider First Line Business Practice Location Address:
3440 S ALAMEDA ST
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:
78411-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-450-4396
Provider Business Practice Location Address Fax Number:
361-851-5111
Provider Enumeration Date:
12/12/2006