Provider First Line Business Practice Location Address:
1310 3RD 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:
78404-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-888-4323
Provider Business Practice Location Address Fax Number:
361-884-5018
Provider Enumeration Date:
07/29/2005