Provider First Line Business Practice Location Address:
1015 AVE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79355-0550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-487-6730
Provider Business Practice Location Address Fax Number:
806-487-6714
Provider Enumeration Date:
12/11/2006