Provider First Line Business Practice Location Address:
11274 MCCOMBS ST
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:
79934-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-242-2400
Provider Business Practice Location Address Fax Number:
915-822-2160
Provider Enumeration Date:
05/08/2006