Provider First Line Business Practice Location Address:
5601 PLUM CREEK DR
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:
79124-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
180-635-1100
Provider Business Practice Location Address Fax Number:
180-635-1386
Provider Enumeration Date:
10/07/2005