Provider First Line Business Practice Location Address:
9584 DYER ST.
Provider Second Line Business Practice Location Address:
SUITE 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:
79924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-751-1007
Provider Business Practice Location Address Fax Number:
915-751-1002
Provider Enumeration Date:
01/18/2013