Provider First Line Business Practice Location Address:
421 W. 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79029-0615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-935-6461
Provider Business Practice Location Address Fax Number:
806-935-6275
Provider Enumeration Date:
04/17/2007