Provider First Line Business Practice Location Address:
1628 19TH 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:
79401-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-219-0500
Provider Business Practice Location Address Fax Number:
806-766-1286
Provider Enumeration Date:
11/30/2006