Provider First Line Business Practice Location Address:
1400 S COULTER ST DEPT OF
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:
79106-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-414-9377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2014