Provider First Line Business Practice Location Address:
5220 80TH 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:
79424-2862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-2400
Provider Business Practice Location Address Fax Number:
806-771-7760
Provider Enumeration Date:
05/18/2006