Provider First Line Business Practice Location Address:
419 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79029-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-934-0555
Provider Business Practice Location Address Fax Number:
806-935-4600
Provider Enumeration Date:
02/26/2007