Provider First Line Business Practice Location Address:
4401 6TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79416-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-687-7394
Provider Business Practice Location Address Fax Number:
806-793-4780
Provider Enumeration Date:
02/12/2007