Provider First Line Business Practice Location Address:
4009 19TH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-9020
Provider Business Practice Location Address Fax Number:
806-795-4726
Provider Enumeration Date:
08/03/2006