Provider First Line Business Practice Location Address:
5811 63RD STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-796-0414
Provider Business Practice Location Address Fax Number:
806-799-7840
Provider Enumeration Date:
12/20/2007