Provider First Line Business Practice Location Address:
421 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANHANDLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-532-2273
Provider Business Practice Location Address Fax Number:
806-532-2276
Provider Enumeration Date:
12/06/2012