Provider First Line Business Practice Location Address:
4413 82ND ST.
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-319-7488
Provider Business Practice Location Address Fax Number:
806-368-5935
Provider Enumeration Date:
09/23/2010