Provider First Line Business Practice Location Address:
1224 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATADOR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-347-2641
Provider Business Practice Location Address Fax Number:
806-347-2780
Provider Enumeration Date:
07/08/2005