Provider First Line Business Practice Location Address:
3712 22ND 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:
79410-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-5561
Provider Business Practice Location Address Fax Number:
806-793-9817
Provider Enumeration Date:
09/22/2005