Provider First Line Business Practice Location Address:
1600 S. COULTER ST.
Provider Second Line Business Practice Location Address:
BLDG. B
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:
806-468-4925
Provider Business Practice Location Address Fax Number:
806-468-4980
Provider Enumeration Date:
07/17/2007