Provider First Line Business Practice Location Address:
5920 66TH ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-5927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-794-6900
Provider Business Practice Location Address Fax Number:
806-794-6912
Provider Enumeration Date:
10/19/2006