Provider First Line Business Practice Location Address:
14 MEDICAL DR
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:
79106-4165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-358-8300
Provider Business Practice Location Address Fax Number:
806-358-8608
Provider Enumeration Date:
06/09/2008