Provider First Line Business Practice Location Address:
2505 B 79TH 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:
79423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-589-0400
Provider Business Practice Location Address Fax Number:
888-606-1222
Provider Enumeration Date:
10/26/2011