Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER DR STE B1
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:
79902-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-845-3122
Provider Business Practice Location Address Fax Number:
915-845-4165
Provider Enumeration Date:
03/27/2018