Provider First Line Business Practice Location Address:
1003 FLINT AVE.
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:
79409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-2636
Provider Business Practice Location Address Fax Number:
806-743-4474
Provider Enumeration Date:
02/14/2007