Provider First Line Business Practice Location Address:
602 ST HWY 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79355-0936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-456-6365
Provider Business Practice Location Address Fax Number:
806-456-2057
Provider Enumeration Date:
11/03/2005