Provider First Line Business Practice Location Address:
5000 W 45TH AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79109-5334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-6003
Provider Business Practice Location Address Fax Number:
806-355-3670
Provider Enumeration Date:
02/18/2008