Provider First Line Business Practice Location Address:
7830 ORLANDO 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:
79423-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-791-0220
Provider Business Practice Location Address Fax Number:
806-791-7490
Provider Enumeration Date:
06/01/2005