Provider First Line Business Practice Location Address:
4010 82ND ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-783-8234
Provider Business Practice Location Address Fax Number:
806-783-8235
Provider Enumeration Date:
12/19/2006