Provider First Line Business Practice Location Address:
608 W HALSELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIMMITT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79027-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-647-3103
Provider Business Practice Location Address Fax Number:
806-647-5433
Provider Enumeration Date:
01/31/2007