Provider First Line Business Practice Location Address:
3601 22ND PL STE A
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:
79410-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-9666
Provider Business Practice Location Address Fax Number:
806-793-3865
Provider Enumeration Date:
01/06/2010