Provider First Line Business Practice Location Address:
6TH & RED RAIDER AVE.
Provider Second Line Business Practice Location Address:
ATF BOX 43021
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-742-5111
Provider Business Practice Location Address Fax Number:
806-742-4265
Provider Enumeration Date:
03/28/2007