Provider First Line Business Practice Location Address:
2202 ITHACA AVE
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:
79410-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-1202
Provider Business Practice Location Address Fax Number:
806-797-4854
Provider Enumeration Date:
11/15/2006