Provider First Line Business Practice Location Address:
4815 ALAMEDA 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:
79905-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-545-8823
Provider Business Practice Location Address Fax Number:
915-545-9799
Provider Enumeration Date:
04/17/2006