Provider First Line Business Practice Location Address:
3010 S GEORGIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79109-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-8320
Provider Business Practice Location Address Fax Number:
806-353-8283
Provider Enumeration Date:
08/03/2006