Provider First Line Business Practice Location Address:
4505 82ND STREET
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-798-3600
Provider Business Practice Location Address Fax Number:
806-798-3601
Provider Enumeration Date:
07/28/2006