Provider First Line Business Practice Location Address:
5424 19TH STREET
Provider Second Line Business Practice Location Address:
SUITE #300
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-4391
Provider Business Practice Location Address Fax Number:
806-796-1354
Provider Enumeration Date:
04/05/2006