Provider First Line Business Practice Location Address:
1600 WALLACE BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR, PICU
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:
806-212-6965
Provider Business Practice Location Address Fax Number:
806-212-6278
Provider Enumeration Date:
05/31/2005