Provider First Line Business Practice Location Address:
3719 22ND ST
Provider Second Line Business Practice Location Address:
STE.B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-785-0600
Provider Business Practice Location Address Fax Number:
806-785-0606
Provider Enumeration Date:
07/28/2005