Provider First Line Business Practice Location Address:
5601 19TH ST
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:
79407-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-777-4416
Provider Business Practice Location Address Fax Number:
806-720-7839
Provider Enumeration Date:
11/11/2006