Provider First Line Business Practice Location Address:
5508 114TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-794-3555
Provider Business Practice Location Address Fax Number:
806-794-9303
Provider Enumeration Date:
02/15/2011