Provider First Line Business Practice Location Address:
8207 ITHACA AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-239-0460
Provider Business Practice Location Address Fax Number:
806-784-0022
Provider Enumeration Date:
08/22/2006