Provider First Line Business Practice Location Address:
1800 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79102-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-379-8282
Provider Business Practice Location Address Fax Number:
806-379-8278
Provider Enumeration Date:
02/27/2007