Provider First Line Business Practice Location Address:
3813 22ND ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-8922
Provider Business Practice Location Address Fax Number:
806-792-2314
Provider Enumeration Date:
08/16/2007