Provider First Line Business Practice Location Address:
1002 FRANKFORD AVE APT 1114C
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:
79416-5071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-537-7269
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2022