Provider First Line Business Practice Location Address:
5015 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
UNIT B-1
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-4357
Provider Business Practice Location Address Fax Number:
806-797-0124
Provider Enumeration Date:
11/02/2006