Provider First Line Business Practice Location Address:
3501 50TH ST
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-763-3024
Provider Business Practice Location Address Fax Number:
806-763-3216
Provider Enumeration Date:
03/08/2007