Provider First Line Business Practice Location Address:
1001 HIGHWAY 83 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILDRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79201-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-937-3636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2007