Provider First Line Business Practice Location Address:
2400 QUAKER AVE
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:
79410-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-2831
Provider Business Practice Location Address Fax Number:
806-792-5023
Provider Enumeration Date:
05/23/2005