Provider First Line Business Practice Location Address:
3404 INTERSTATE 27
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:
79404-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-744-8477
Provider Business Practice Location Address Fax Number:
806-744-8483
Provider Enumeration Date:
08/16/2005