Provider First Line Business Practice Location Address:
3223 S LOOP 289
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-5522
Provider Business Practice Location Address Fax Number:
806-785-7582
Provider Enumeration Date:
07/28/2009