Provider First Line Business Practice Location Address:
WHITE ROCK MED CLINIC STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE ROCK
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-672-3701
Provider Business Practice Location Address Fax Number:
505-672-0369
Provider Enumeration Date:
07/30/2006