Provider First Line Business Practice Location Address:
3709 22ND PL
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-2616
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2011