Provider First Line Business Practice Location Address:
1001 US HIGHWAY 83 N
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:
79201-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-2757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2012