Provider First Line Business Practice Location Address:
1802 E 50TH ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79404-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-1160
Provider Business Practice Location Address Fax Number:
806-771-1162
Provider Enumeration Date:
09/23/2014