Provider First Line Business Practice Location Address:
5301 73RD ST
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-252-3421
Provider Business Practice Location Address Fax Number:
806-698-9244
Provider Enumeration Date:
03/12/2010