Provider First Line Business Practice Location Address:
6401 INDIANA AVE
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:
79413-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-6868
Provider Business Practice Location Address Fax Number:
806-771-7444
Provider Enumeration Date:
07/02/2006