Provider First Line Business Practice Location Address:
8806 UNIVERSITY AVE
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:
79423-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-2660
Provider Business Practice Location Address Fax Number:
806-792-1347
Provider Enumeration Date:
11/29/2005