Provider First Line Business Practice Location Address:
3610 24TH ST
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:
79410-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-3141
Provider Business Practice Location Address Fax Number:
806-771-2235
Provider Enumeration Date:
06/09/2006