Provider First Line Business Practice Location Address:
2402 52ND ST
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79412-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-791-4045
Provider Business Practice Location Address Fax Number:
806-791-4090
Provider Enumeration Date:
04/02/2007