Provider First Line Business Practice Location Address:
2232 INDIANA AVE
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-6160
Provider Business Practice Location Address Fax Number:
806-799-0825
Provider Enumeration Date:
10/18/2006