Provider First Line Business Practice Location Address:
4130 S. ALAMEDA STREET
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:
78411-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-855-6243
Provider Business Practice Location Address Fax Number:
361-855-0730
Provider Enumeration Date:
01/16/2009