Provider First Line Business Practice Location Address:
9801 CARNEGIE 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:
79925-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-595-3356
Provider Business Practice Location Address Fax Number:
915-595-3359
Provider Enumeration Date:
07/14/2006