Provider First Line Business Practice Location Address:
3132 50TH ST
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:
79413-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-4041
Provider Business Practice Location Address Fax Number:
806-209-0105
Provider Enumeration Date:
09/13/2008