Provider First Line Business Practice Location Address:
2132 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:
79412-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-747-1635
Provider Business Practice Location Address Fax Number:
806-747-5499
Provider Enumeration Date:
05/12/2007