Provider First Line Business Practice Location Address:
1001 S POLK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79101-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-342-2500
Provider Business Practice Location Address Fax Number:
806-372-2433
Provider Enumeration Date:
01/28/2009