Provider First Line Business Practice Location Address:
401 SW 12TH 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:
79101-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-337-4040
Provider Business Practice Location Address Fax Number:
806-337-5075
Provider Enumeration Date:
02/08/2007