Provider First Line Business Practice Location Address:
12814 OSMOTHERLEY AVE
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:
79928-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-252-2241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2026