Provider First Line Business Practice Location Address:
1901 MEDI-PARK
Provider Second Line Business Practice Location Address:
SUITE 1059
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-356-2770
Provider Business Practice Location Address Fax Number:
806-356-2939
Provider Enumeration Date:
07/27/2006