Provider First Line Business Practice Location Address:
5102 SALEM AVE
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:
79414-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-687-8080
Provider Business Practice Location Address Fax Number:
806-771-6862
Provider Enumeration Date:
10/26/2011