Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
STE 212
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-3977
Provider Business Practice Location Address Fax Number:
915-532-5866
Provider Enumeration Date:
07/01/2005