Provider First Line Business Practice Location Address:
5203 79TH ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-799-6780
Provider Business Practice Location Address Fax Number:
806-698-0668
Provider Enumeration Date:
04/10/2007