Provider First Line Business Practice Location Address:
3819 24TH ST
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:
79410-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-7000
Provider Business Practice Location Address Fax Number:
806-797-7055
Provider Enumeration Date:
12/17/2007