Provider First Line Business Practice Location Address:
1313 COUNTY ROAD 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMESA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79331-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-872-6741
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2006