Provider First Line Business Practice Location Address:
201 N ALAMEDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-4933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-234-2008
Provider Business Practice Location Address Fax Number:
505-885-1075
Provider Enumeration Date:
10/10/2006