Provider First Line Business Practice Location Address:
3502 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79415-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-761-0737
Provider Business Practice Location Address Fax Number:
806-761-0738
Provider Enumeration Date:
04/25/2006