Provider First Line Business Practice Location Address:
5004 FRANKFORD AVE UNIT 400
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:
79424-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2011