Provider First Line Business Practice Location Address:
3419 22ND ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-5421
Provider Business Practice Location Address Fax Number:
806-793-0759
Provider Enumeration Date:
08/04/2006