Provider First Line Business Practice Location Address:
201 NW 2ND 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:
79027-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-647-3151
Provider Business Practice Location Address Fax Number:
806-647-3313
Provider Enumeration Date:
08/31/2006