Provider First Line Business Practice Location Address:
840 E REDD RD
Provider Second Line Business Practice Location Address:
BLDG 1-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:
79912-7264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-581-1771
Provider Business Practice Location Address Fax Number:
915-581-5772
Provider Enumeration Date:
01/28/2008