Provider First Line Business Practice Location Address:
4102 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-8150
Provider Business Practice Location Address Fax Number:
806-791-6688
Provider Enumeration Date:
06/21/2005