Provider First Line Business Practice Location Address:
545 E REDD RD
Provider Second Line Business Practice Location Address:
SUITE C-2
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-1293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-298-1008
Provider Business Practice Location Address Fax Number:
915-298-1009
Provider Enumeration Date:
01/12/2007