Provider First Line Business Practice Location Address:
5002 34TH ST UNIT B
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:
79410-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-9701
Provider Business Practice Location Address Fax Number:
806-771-9703
Provider Enumeration Date:
08/21/2006