Provider First Line Business Practice Location Address:
5214 68TH ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-1598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-698-6200
Provider Business Practice Location Address Fax Number:
806-796-2387
Provider Enumeration Date:
01/15/2008