Provider First Line Business Practice Location Address:
1900 S COULTER ST STE P
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:
79106-1795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-1700
Provider Business Practice Location Address Fax Number:
806-355-1800
Provider Enumeration Date:
05/11/2009