Provider First Line Business Practice Location Address:
4601 50TH ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79414-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-785-8000
Provider Business Practice Location Address Fax Number:
806-792-7174
Provider Enumeration Date:
04/10/2006