Provider First Line Business Practice Location Address:
125 AVENUE B NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILDRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79201-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-937-2015
Provider Business Practice Location Address Fax Number:
940-937-6889
Provider Enumeration Date:
11/27/2007