Provider First Line Business Practice Location Address:
3802 21ST ST
Provider Second Line Business Practice Location Address:
C
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-791-5140
Provider Business Practice Location Address Fax Number:
806-791-0454
Provider Enumeration Date:
08/30/2006