Provider First Line Business Practice Location Address:
12371 EDGEMERE BLVD
Provider Second Line Business Practice Location Address:
SUITES 207 - 209
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-856-0008
Provider Business Practice Location Address Fax Number:
915-856-0064
Provider Enumeration Date:
03/13/2014