Provider First Line Business Practice Location Address:
9615 FRANKFORD AVENUE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-761-0267
Provider Business Practice Location Address Fax Number:
806-761-0268
Provider Enumeration Date:
11/22/2005