Provider First Line Business Practice Location Address:
820 E REDD RD BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-7275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-581-0712
Provider Business Practice Location Address Fax Number:
915-533-8680
Provider Enumeration Date:
04/24/2012