Provider First Line Business Practice Location Address:
836 E REDD RD
Provider Second Line Business Practice Location Address:
SUITE 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:
79912-7221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-845-4060
Provider Business Practice Location Address Fax Number:
915-845-4065
Provider Enumeration Date:
10/22/2008