Provider First Line Business Practice Location Address:
8150 US HIGHWAY 287
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILDRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79201-7152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-536-3644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2009