Provider First Line Business Practice Location Address:
2105 AVENUE F NW
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:
79201-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-937-8242
Provider Business Practice Location Address Fax Number:
940-937-2054
Provider Enumeration Date:
11/03/2005