Provider First Line Business Practice Location Address:
3315 81ST ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-2035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-6200
Provider Business Practice Location Address Fax Number:
806-793-6319
Provider Enumeration Date:
07/27/2005