Provider First Line Business Practice Location Address:
3234 64TH STREET
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:
79413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-2311
Provider Business Practice Location Address Fax Number:
806-792-8730
Provider Enumeration Date:
09/20/2006