Provider First Line Business Practice Location Address:
1221 E SAN ANTONIO 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:
79901-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-546-4008
Provider Business Practice Location Address Fax Number:
915-351-2314
Provider Enumeration Date:
03/16/2007