Provider First Line Business Practice Location Address:
310 W HALSELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIMMITT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79027-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-647-2191
Provider Business Practice Location Address Fax Number:
806-647-2407
Provider Enumeration Date:
07/15/2005