Provider First Line Business Practice Location Address:
6202 82ND 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:
79424-3691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-687-8008
Provider Business Practice Location Address Fax Number:
806-687-8009
Provider Enumeration Date:
11/30/2006