Provider First Line Business Practice Location Address:
HWY 83 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILDRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-937-6371
Provider Business Practice Location Address Fax Number:
940-937-9626
Provider Enumeration Date:
07/13/2006