Provider First Line Business Practice Location Address:
3108 S. FILLMORE 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:
79110-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-374-5516
Provider Business Practice Location Address Fax Number:
806-373-9446
Provider Enumeration Date:
05/25/2006