Provider First Line Business Practice Location Address:
3601 4TH ST
Provider Second Line Business Practice Location Address:
STE 2A300
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79430-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-5678
Provider Business Practice Location Address Fax Number:
806-743-5670
Provider Enumeration Date:
06/22/2007