Provider First Line Business Practice Location Address:
1109 KEMPER 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:
79403-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-767-0422
Provider Business Practice Location Address Fax Number:
806-767-0442
Provider Enumeration Date:
12/08/2006