Provider First Line Business Practice Location Address:
7322 19TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-785-9433
Provider Business Practice Location Address Fax Number:
806-785-9517
Provider Enumeration Date:
02/15/2007