Provider First Line Business Practice Location Address:
1600 S. COUTER ST. G-500
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:
806-356-9500
Provider Business Practice Location Address Fax Number:
806-356-9573
Provider Enumeration Date:
08/17/2006