Provider First Line Business Practice Location Address:
5255 79TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-794-7171
Provider Business Practice Location Address Fax Number:
806-798-1168
Provider Enumeration Date:
01/12/2007