Provider First Line Business Practice Location Address:
706 SOUTH FIRST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMESA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79331-0541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-872-7664
Provider Business Practice Location Address Fax Number:
806-872-5334
Provider Enumeration Date:
10/31/2006