Provider First Line Business Practice Location Address:
1600 S COULTER ST
Provider Second Line Business Practice Location Address:
E701
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-367-8480
Provider Business Practice Location Address Fax Number:
806-367-7789
Provider Enumeration Date:
11/07/2006