Provider First Line Business Practice Location Address:
4014 22ND PLACE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-2122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2005