Provider First Line Business Practice Location Address:
7302 UNIVERSITY AVE
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:
79423-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-748-6456
Provider Business Practice Location Address Fax Number:
806-748-6456
Provider Enumeration Date:
06/25/2011