Provider First Line Business Practice Location Address:
3004-50TH ST.
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-785-4540
Provider Business Practice Location Address Fax Number:
806-785-4549
Provider Enumeration Date:
07/17/2006