Provider First Line Business Practice Location Address:
800 S BAKER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTHRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79236-0111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-596-4111
Provider Business Practice Location Address Fax Number:
806-596-4044
Provider Enumeration Date:
01/16/2007