Provider First Line Business Practice Location Address:
207 N. UNION STE. E
Provider Second Line Business Practice Location Address:
OMS OF SE NM, LLC
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-623-5711
Provider Business Practice Location Address Fax Number:
575-623-8628
Provider Enumeration Date:
09/24/2010