Provider First Line Business Practice Location Address:
1626 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
5TH FLOOR, SUITE 503
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-546-9200
Provider Business Practice Location Address Fax Number:
915-546-9800
Provider Enumeration Date:
09/29/2006