Provider First Line Business Practice Location Address:
500 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
LARRY K DURHAM SPORTS MEDICINE COMPLEX
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79968-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-747-5225
Provider Business Practice Location Address Fax Number:
915-747-6801
Provider Enumeration Date:
08/12/2012