Provider First Line Business Practice Location Address:
5400 ALAMEDA AVE STE A
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:
79905-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-521-5400
Provider Business Practice Location Address Fax Number:
915-521-2297
Provider Enumeration Date:
03/15/2010