Provider First Line Business Practice Location Address:
1701 BASSETT AVE STE 115
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:
79901-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-799-1782
Provider Business Practice Location Address Fax Number:
915-205-6909
Provider Enumeration Date:
02/27/2024