Provider First Line Business Practice Location Address:
6310 GENOA AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-687-9957
Provider Business Practice Location Address Fax Number:
888-456-2402
Provider Enumeration Date:
02/22/2010