Provider First Line Business Practice Location Address:
3601 4TH STREET
Provider Second Line Business Practice Location Address:
STOP 9406
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79430-9406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-7336
Provider Business Practice Location Address Fax Number:
806-743-7329
Provider Enumeration Date:
08/16/2006