Provider First Line Business Practice Location Address:
3401 N UNIVERSITY 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:
79415-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-741-3609
Provider Business Practice Location Address Fax Number:
806-741-3604
Provider Enumeration Date:
12/21/2006