Provider First Line Business Practice Location Address:
2012 S WASHINGTON ST
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:
79109-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-379-6191
Provider Business Practice Location Address Fax Number:
806-379-8960
Provider Enumeration Date:
09/20/2006