Provider First Line Business Practice Location Address:
3601 4TH ST LUBBOCK TX 79430
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:
79430-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-1798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2025