Provider First Line Business Practice Location Address:
4425 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-788-2015
Provider Business Practice Location Address Fax Number:
806-788-2016
Provider Enumeration Date:
12/31/2015