Provider First Line Business Practice Location Address:
1520 N CAMPBELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-920-7205
Provider Business Practice Location Address Fax Number:
915-351-6601
Provider Enumeration Date:
12/19/2006