Provider First Line Business Practice Location Address:
3805 22ND 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:
79410-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-5882
Provider Business Practice Location Address Fax Number:
806-687-9002
Provider Enumeration Date:
08/03/2006