Provider First Line Business Practice Location Address:
1440 GEORGE DIETER
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-591-4444
Provider Business Practice Location Address Fax Number:
915-921-9000
Provider Enumeration Date:
07/20/2005