Provider First Line Business Practice Location Address:
4002 22ND PL
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:
79410-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-725-6327
Provider Business Practice Location Address Fax Number:
806-725-4942
Provider Enumeration Date:
10/19/2005