Provider First Line Business Practice Location Address:
3502 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:
79423-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-788-1844
Provider Business Practice Location Address Fax Number:
806-788-1843
Provider Enumeration Date:
10/24/2006