Provider First Line Business Practice Location Address:
1406 E COUNTY ROAD 5800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79403-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-310-4999
Provider Business Practice Location Address Fax Number:
817-310-4990
Provider Enumeration Date:
01/24/2007