Provider First Line Business Practice Location Address:
2214 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMESA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79331-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-526-2393
Provider Business Practice Location Address Fax Number:
866-422-8797
Provider Enumeration Date:
04/06/2026