Provider First Line Business Practice Location Address:
5301 50TH STREET #200
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:
79414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-2759
Provider Business Practice Location Address Fax Number:
806-792-3739
Provider Enumeration Date:
10/11/2006