Provider First Line Business Practice Location Address:
840 REDD RD
Provider Second Line Business Practice Location Address:
BLDG 1-B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-581-1771
Provider Business Practice Location Address Fax Number:
915-581-5772
Provider Enumeration Date:
07/09/2006