Provider First Line Business Practice Location Address:
2412 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:
79412-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-788-4000
Provider Business Practice Location Address Fax Number:
806-788-4278
Provider Enumeration Date:
05/13/2013