Provider First Line Business Practice Location Address:
4920 S LOOP 289
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79414-4797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-744-1887
Provider Business Practice Location Address Fax Number:
806-744-5545
Provider Enumeration Date:
10/03/2006