Provider First Line Business Practice Location Address:
3601 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 4B174
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79430-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-7337
Provider Business Practice Location Address Fax Number:
806-743-2314
Provider Enumeration Date:
11/02/2005