Provider First Line Business Practice Location Address:
9473 SOCORRO RD
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:
79907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-860-6113
Provider Business Practice Location Address Fax Number:
915-860-6166
Provider Enumeration Date:
11/08/2006