Provider First Line Business Practice Location Address:
2412 50TH ST
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:
79412-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-744-7223
Provider Business Practice Location Address Fax Number:
806-740-3325
Provider Enumeration Date:
06/15/2006