Provider First Line Business Practice Location Address:
3111 110TH ST
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-0813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-368-8173
Provider Business Practice Location Address Fax Number:
806-368-8173
Provider Enumeration Date:
08/02/2005