Provider First Line Business Practice Location Address:
1901 MEDIPARK DR.
Provider Second Line Business Practice Location Address:
BLDG C SUITE 3
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-353-1217
Provider Business Practice Location Address Fax Number:
806-353-1222
Provider Enumeration Date:
01/20/2022