Provider First Line Business Practice Location Address:
3601 21ST
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:
79410-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-2222
Provider Business Practice Location Address Fax Number:
806-792-7287
Provider Enumeration Date:
11/16/2006