Provider First Line Business Practice Location Address:
10175 GATEWAY WEST, MEDICAL PLAZA II
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-283-3959
Provider Business Practice Location Address Fax Number:
915-283-3954
Provider Enumeration Date:
04/06/2022