Provider First Line Business Practice Location Address:
5002 50TH ST
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:
79414-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-699-6188
Provider Business Practice Location Address Fax Number:
806-792-9453
Provider Enumeration Date:
10/12/2005