Provider First Line Business Practice Location Address:
3709 22ND PLACE SUITE C
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:
79410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-3911
Provider Business Practice Location Address Fax Number:
806-795-2315
Provider Enumeration Date:
08/09/2006