Provider First Line Business Practice Location Address:
3805 22ND ST
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-4327
Provider Business Practice Location Address Fax Number:
806-577-4148
Provider Enumeration Date:
06/08/2006