Provider First Line Business Practice Location Address:
11160 LA QUINTA PLACE
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:
79936-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-591-1494
Provider Business Practice Location Address Fax Number:
915-598-0610
Provider Enumeration Date:
12/18/2006