Provider First Line Business Practice Location Address:
8220 MEMPHIS AVE
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:
79423-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-745-1745
Provider Business Practice Location Address Fax Number:
806-771-1795
Provider Enumeration Date:
03/12/2007