Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 211
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:
915-545-5453
Provider Business Practice Location Address Fax Number:
915-544-2572
Provider Enumeration Date:
11/21/2006