Provider First Line Business Practice Location Address:
5005 N. PIEDRAS ST
Provider Second Line Business Practice Location Address:
ATTN: MCHM-ACM
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-1439
Provider Business Practice Location Address Fax Number:
915-744-6079
Provider Enumeration Date:
02/06/2007