Provider First Line Business Practice Location Address:
2714 82ND ST STE A
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:
79423-1459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-281-1000
Provider Business Practice Location Address Fax Number:
806-686-1336
Provider Enumeration Date:
07/31/2006