Provider First Line Business Practice Location Address:
6424 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:
79416-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-696-4865
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2021