Provider First Line Business Practice Location Address:
1902 50TH 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:
79412-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-1386
Provider Business Practice Location Address Fax Number:
806-771-1388
Provider Enumeration Date:
11/15/2006