Provider First Line Business Practice Location Address:
4630 50TH ST
Provider Second Line Business Practice Location Address:
SUITE 509
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79414-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-8808
Provider Business Practice Location Address Fax Number:
806-771-8809
Provider Enumeration Date:
12/15/2009