Provider First Line Business Practice Location Address:
6344 EDGEMERE BLVD
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:
79925-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-881-0800
Provider Business Practice Location Address Fax Number:
915-881-0803
Provider Enumeration Date:
05/05/2006