Provider First Line Business Practice Location Address:
3702 20TH ST
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:
79410-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-791-5930
Provider Business Practice Location Address Fax Number:
806-791-5937
Provider Enumeration Date:
07/29/2005