Provider First Line Business Practice Location Address:
419 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79029-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-934-3287
Provider Business Practice Location Address Fax Number:
806-934-3292
Provider Enumeration Date:
10/20/2009