Provider First Line Business Practice Location Address:
8212 ITHACA AVE
Provider Second Line Business Practice Location Address:
STE E-G
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-8727
Provider Business Practice Location Address Fax Number:
806-792-8786
Provider Enumeration Date:
01/10/2006