Provider First Line Business Practice Location Address:
1501 N MESA ST
Provider Second Line Business Practice Location Address:
SUITE 2-B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-1222
Provider Business Practice Location Address Fax Number:
915-532-1551
Provider Enumeration Date:
11/26/2007