Provider First Line Business Practice Location Address:
1313 CR 19
Provider Second Line Business Practice Location Address:
SMITH UNIT
Provider Business Practice Location Address City Name:
LAMESA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-541-7731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007