Provider First Line Business Practice Location Address:
5415 114TH 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:
79424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-712-5715
Provider Business Practice Location Address Fax Number:
806-722-1182
Provider Enumeration Date:
11/11/2009