Provider First Line Business Practice Location Address:
5152 69TH SUITE 101
Provider Second Line Business Practice Location Address:
SUITE 101 BOX #2
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:
906-794-4009
Provider Business Practice Location Address Fax Number:
806-794-1091
Provider Enumeration Date:
04/27/2020