Provider First Line Business Practice Location Address:
3021 20TH 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:
79410-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-441-2940
Provider Business Practice Location Address Fax Number:
806-498-1642
Provider Enumeration Date:
11/28/2006