Provider First Line Business Practice Location Address:
3223 S LOOP 289
Provider Second Line Business Practice Location Address:
SUITE 240-U
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-794-4261
Provider Business Practice Location Address Fax Number:
800-462-4189
Provider Enumeration Date:
09/16/2006