Provider First Line Business Practice Location Address:
3379 WEDGEWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 3
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:
915-598-0281
Provider Business Practice Location Address Fax Number:
915-598-7971
Provider Enumeration Date:
02/15/2007