Provider First Line Business Practice Location Address:
5217 LEHIGH 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:
79416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-478-2863
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2018