Provider First Line Business Practice Location Address:
1387 GEORGE DIETER DR BLDG B
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:
79936-7410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-275-0224
Provider Business Practice Location Address Fax Number:
915-275-0225
Provider Enumeration Date:
11/01/2006