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:
79106-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-359-0718
Provider Business Practice Location Address Fax Number:
806-359-9613
Provider Enumeration Date:
09/06/2006