Provider First Line Business Practice Location Address:
9301 VENTURA AVENUE
Provider Second Line Business Practice Location Address:
NORTH STAR ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-856-6578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007