Provider First Line Business Practice Location Address:
701 WEST 5TH STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF INTERNAL MEDICINE, SUITE 3106
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-703-4350
Provider Business Practice Location Address Fax Number:
432-335-5297
Provider Enumeration Date:
11/08/2005