Provider First Line Business Practice Location Address:
405 50TH ST
Provider Second Line Business Practice Location Address:
SUITE #17
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79404-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-777-7734
Provider Business Practice Location Address Fax Number:
806-745-2285
Provider Enumeration Date:
08/12/2006