Provider First Line Business Practice Location Address:
5113 150TH ST
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:
79424-6631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-863-3885
Provider Business Practice Location Address Fax Number:
806-863-3244
Provider Enumeration Date:
07/31/2006