Provider First Line Business Practice Location Address:
12800 EDGEMERE BLVD STE A
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:
79938-4693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-504-6939
Provider Business Practice Location Address Fax Number:
915-504-6937
Provider Enumeration Date:
06/15/2022