Provider First Line Business Practice Location Address:
9615 FRANKFORD AVE FL 1
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:
79424-4461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-761-0265
Provider Business Practice Location Address Fax Number:
806-761-0266
Provider Enumeration Date:
08/22/2007