Provider First Line Business Practice Location Address:
6023 82ND STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-0806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-544-6881
Provider Business Practice Location Address Fax Number:
817-578-3098
Provider Enumeration Date:
09/08/2008