Provider First Line Business Practice Location Address:
2712 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:
79423-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-745-6644
Provider Business Practice Location Address Fax Number:
806-748-1518
Provider Enumeration Date:
07/21/2008