Provider First Line Business Practice Location Address:
2421 27TH 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:
79411-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-8039
Provider Business Practice Location Address Fax Number:
806-792-8039
Provider Enumeration Date:
07/25/2006