Provider First Line Business Practice Location Address:
8212 ITHACA AVE
Provider Second Line Business Practice Location Address:
SUITE W6
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-787-8669
Provider Business Practice Location Address Fax Number:
806-866-2046
Provider Enumeration Date:
09/08/2009