Provider First Line Business Practice Location Address:
4415 66TH ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79414-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-4443
Provider Business Practice Location Address Fax Number:
806-795-1563
Provider Enumeration Date:
02/27/2007