Provider First Line Business Practice Location Address:
3719 MCKINLEY AVE
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:
79930-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-231-6436
Provider Business Practice Location Address Fax Number:
915-231-6436
Provider Enumeration Date:
01/23/2009