Provider First Line Business Practice Location Address:
11165 LA QUINTA PLACE
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:
79936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-591-1999
Provider Business Practice Location Address Fax Number:
915-591-3201
Provider Enumeration Date:
11/09/2006