Provider First Line Business Practice Location Address:
MEDICAL PLAZA II 10175 GATEWAY BLVD WEST
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-283-3953
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2025