Provider First Line Business Practice Location Address: 
1625 MEDICAL CENTER DR
    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: 
79902-5005
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
915-747-4000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/09/2022