Provider First Line Business Practice Location Address:
1008 CARTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BLISS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79916-6709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-569-8438
Provider Business Practice Location Address Fax Number:
915-569-5712
Provider Enumeration Date:
08/01/2008