Provider First Line Business Practice Location Address:
6014 45TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407-3773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-252-1928
Provider Business Practice Location Address Fax Number:
806-788-1993
Provider Enumeration Date:
09/14/2006