Provider First Line Business Practice Location Address:
1101 N CAMPBELL 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:
79902-4238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-747-8215
Provider Business Practice Location Address Fax Number:
915-747-8211
Provider Enumeration Date:
06/09/2008