Provider First Line Business Practice Location Address:
18511 HIGHLANDER MEDICS ST, WBAMC
Provider Second Line Business Practice Location Address:
MCHM-DOS-GSR
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-0730
Provider Business Practice Location Address Fax Number:
915-742-7889
Provider Enumeration Date:
03/09/2018