Provider First Line Business Practice Location Address:
5009 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-712-1096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2016