Provider First Line Business Practice Location Address:
5407 4TH ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79416-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-549-6696
Provider Business Practice Location Address Fax Number:
806-791-3934
Provider Enumeration Date:
11/06/2007