Provider First Line Business Practice Location Address:
2559 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-8703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-434-2229
Provider Business Practice Location Address Fax Number:
505-439-5705
Provider Enumeration Date:
01/11/2006