Provider First Line Business Mailing Address:
5005 N. PIEDRAS STREET
Provider Second Line Business Mailing Address:
ATTN: MS. MARY H. SEXTON, CREDENTIALS COORDINATOR
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79920-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-742-2973
Provider Business Mailing Address Fax Number:
915-742-4890