Provider First Line Business Practice Location Address:
204 E 16TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DALHART
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79022-4845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-244-5668
Provider Business Practice Location Address Fax Number:
806-244-8371
Provider Enumeration Date:
03/10/2011