Provider First Line Business Practice Location Address: 
1700 N. OREGON ST., SUITE 630
    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: 
79902-3582
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
915-838-1900
    Provider Business Practice Location Address Fax Number: 
915-838-1906
    Provider Enumeration Date: 
06/06/2011