Provider First Line Business Practice Location Address:
5303 50TH STREET
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:
79414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-799-8950
Provider Business Practice Location Address Fax Number:
806-792-9404
Provider Enumeration Date:
05/08/2006