Provider First Line Business Practice Location Address:
7405 82ND 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:
79424-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-4976
Provider Business Practice Location Address Fax Number:
806-771-2433
Provider Enumeration Date:
06/28/2011