Provider First Line Business Practice Location Address:
18TH AND BOSTON
Provider Second Line Business Practice Location Address:
TEXAS TECH UNIVERSITY
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79409-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-742-3711
Provider Business Practice Location Address Fax Number:
806-742-3799
Provider Enumeration Date:
10/18/2010