Provider First Line Business Practice Location Address:
3809 22ND ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-9155
Provider Business Practice Location Address Fax Number:
806-793-3825
Provider Enumeration Date:
04/03/2007