Provider First Line Business Practice Location Address:
6520 UNIVERSITY AVE SPC 5
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:
79413-5811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-340-0713
Provider Business Practice Location Address Fax Number:
806-340-0714
Provider Enumeration Date:
07/13/2017