Provider First Line Business Practice Location Address:
4625 ALABAMA ST. STE. B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
79930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-288-3207
Provider Business Practice Location Address Fax Number:
180-075-5194
Provider Enumeration Date:
02/08/2012