Provider First Line Business Practice Location Address:
7678 ALAMEDA AVE
Provider Second Line Business Practice Location Address:
SPACE B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79915-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-772-5900
Provider Business Practice Location Address Fax Number:
915-772-5975
Provider Enumeration Date:
11/15/2005