Provider First Line Business Practice Location Address:
C/O LUBBOCK AREA OFFICE
Provider Second Line Business Practice Location Address:
6630 QUAKER AVENUE, SUITE 208
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-745-1021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006