Provider First Line Business Practice Location Address:
1500 S COULTER ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-0404
Provider Business Practice Location Address Fax Number:
806-354-2810
Provider Enumeration Date:
03/26/2008