Provider First Line Business Practice Location Address:
5809 27TH ST APT 1
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:
79407-3289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-344-1188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2026