Provider First Line Business Practice Location Address:
1408 S. JEFFERESON STREET
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79101-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-373-8100
Provider Business Practice Location Address Fax Number:
806-378-9996
Provider Enumeration Date:
10/03/2006