Provider First Line Business Practice Location Address:
5005 N PIEDRAS ST
Provider Second Line Business Practice Location Address:
WILLIAM BEAUMONT ARMY MEDICAL CENTER (11E, DBH)
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-1640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2015