Provider First Line Business Practice Location Address: 
1 W MEDICAL CT
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WICHITA FALLS
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
76310-1767
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
940-692-4688
    Provider Business Practice Location Address Fax Number: 
940-692-8388
    Provider Enumeration Date: 
03/05/2025