Provider First Line Business Practice Location Address:
210 DENVER AVE UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALHART
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79022-2731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-676-5756
Provider Business Practice Location Address Fax Number:
806-244-0036
Provider Enumeration Date:
09/27/2005