Provider First Line Business Practice Location Address:
4009 19TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-790-5897
Provider Business Practice Location Address Fax Number:
806-687-0380
Provider Enumeration Date:
10/03/2007