Provider First Line Business Practice Location Address:
3601 21ST ST
Provider Second Line Business Practice Location Address:
SUITE 3-A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-7877
Provider Business Practice Location Address Fax Number:
806-771-7474
Provider Enumeration Date:
02/01/2006