Provider First Line Business Practice Location Address:
3513 50TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-6393
Provider Business Practice Location Address Fax Number:
806-797-6397
Provider Enumeration Date:
12/27/2006