Provider First Line Business Practice Location Address:
10651 E ST
Provider Second Line Business Practice Location Address:
CODE: 00RMB
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-961-6079
Provider Business Practice Location Address Fax Number:
361-961-2611
Provider Enumeration Date:
03/14/2006