Provider First Line Business Practice Location Address:
1719 AVENUE A
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:
79401-5334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-765-5311
Provider Business Practice Location Address Fax Number:
806-765-0225
Provider Enumeration Date:
12/26/2006