Provider First Line Business Practice Location Address:
505 N. PIEDRAS STREET
Provider Second Line Business Practice Location Address:
ATTN MS LAURA PORTER
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-568-5935
Provider Business Practice Location Address Fax Number:
915-568-5174
Provider Enumeration Date:
08/31/2006