Provider First Line Business Practice Location Address:
1401 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79029-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-935-2725
Provider Business Practice Location Address Fax Number:
806-935-2680
Provider Enumeration Date:
04/15/2014