Provider First Line Business Practice Location Address:
3502 9TH STREET
Provider Second Line Business Practice Location Address:
STE. 280
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79401-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-765-2611
Provider Business Practice Location Address Fax Number:
806-687-5826
Provider Enumeration Date:
07/29/2006