Provider First Line Business Practice Location Address:
3002 50TH 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:
79413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-9197
Provider Business Practice Location Address Fax Number:
806-793-7527
Provider Enumeration Date:
11/30/2005