Provider First Line Business Practice Location Address:
1224 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-854-0201
Provider Business Practice Location Address Fax Number:
361-855-7572
Provider Enumeration Date:
05/12/2006