Provider First Line Business Practice Location Address:
5225 S. LOOP 289 SUITE 210
Provider Second Line Business Practice Location Address:
SENTRY PLAZA TWO OFFICE BLDG
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-780-4180
Provider Business Practice Location Address Fax Number:
806-780-4181
Provider Enumeration Date:
11/28/2006