Provider First Line Business Practice Location Address:
2424 50TH ST RM 303
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:
79412-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-8853
Provider Business Practice Location Address Fax Number:
806-797-9407
Provider Enumeration Date:
03/30/2007