Provider First Line Business Practice Location Address:
6102 82ND ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-0802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-799-8160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006