Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-313-9569
Provider Business Practice Location Address Fax Number:
915-313-0487
Provider Enumeration Date:
07/30/2006