Provider First Line Business Practice Location Address:
1600 MEDICAL CTR
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-838-1900
Provider Business Practice Location Address Fax Number:
915-838-1906
Provider Enumeration Date:
06/23/2008