Provider First Line Business Practice Location Address:
4421 EDGAR PARK 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:
79904-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-757-2874
Provider Business Practice Location Address Fax Number:
915-751-3240
Provider Enumeration Date:
10/17/2006