Provider First Line Business Practice Location Address:
5004 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
STE 119
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-589-6233
Provider Business Practice Location Address Fax Number:
844-369-9210
Provider Enumeration Date:
11/23/2009