Provider First Line Business Practice Location Address:
2738 68TH 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:
79413-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-445-0491
Provider Business Practice Location Address Fax Number:
806-785-2094
Provider Enumeration Date:
09/16/2006