Provider First Line Business Practice Location Address:
3709 22ND PL UNIT B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-2618
Provider Business Practice Location Address Fax Number:
806-791-3122
Provider Enumeration Date:
09/07/2006