Provider First Line Business Practice Location Address:
5020 50TH ST UNIT 101
Provider Second Line Business Practice Location Address:
YORKTOWN PLAZA
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79414-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-548-6061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2012