Provider First Line Business Practice Location Address:
5001 N PIEDRAS ST
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:
79930-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-564-6159
Provider Business Practice Location Address Fax Number:
915-564-7861
Provider Enumeration Date:
02/07/2012