Provider First Line Business Practice Location Address:
4 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-331-5284
Provider Business Practice Location Address Fax Number:
806-331-5282
Provider Enumeration Date:
10/22/2009