Provider First Line Business Practice Location Address:
4102 22ND PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-725-0237
Provider Business Practice Location Address Fax Number:
806-725-1030
Provider Enumeration Date:
10/25/2006