Provider First Line Business Practice Location Address:
1400 WALLACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-5620
Provider Business Practice Location Address Fax Number:
806-351-3783
Provider Enumeration Date:
07/31/2006