Provider First Line Business Practice Location Address:
2818 S LIPSCOMB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79109-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-576-6432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006