Provider First Line Business Practice Location Address:
1010 SPRUCE ST
Provider Second Line Business Practice Location Address:
ESPANOLA HOSPITAL
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-753-7111
Provider Business Practice Location Address Fax Number:
505-753-4438
Provider Enumeration Date:
10/03/2006