Provider First Line Business Practice Location Address:
801 S FILLMORE ST
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:
79101-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-379-6901
Provider Business Practice Location Address Fax Number:
806-379-6875
Provider Enumeration Date:
07/18/2007