Provider First Line Business Mailing Address:
4800 ALBERTA AVE., STE. 101
Provider Second Line Business Mailing Address:
CREDENTIALING OFFICE
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79905-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-545-6720
Provider Business Mailing Address Fax Number:
915-575-5755