Provider First Line Business Practice Location Address:
1200 WALLACE BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-359-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2007