Provider First Line Business Practice Location Address:
1901 MEDI PARK
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-353-2111
Provider Business Practice Location Address Fax Number:
806-354-8277
Provider Enumeration Date:
05/19/2006