Provider First Line Business Practice Location Address:
4 MEDICAL DR STE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-351-1775
Provider Business Practice Location Address Fax Number:
806-351-1754
Provider Enumeration Date:
06/30/2005