Provider First Line Business Practice Location Address:
200 W WILSHIRE, SUITE A
Provider Second Line Business Practice Location Address:
LA CASA FAMILY HEALTH CENTER/LOS NINOS PEDIATRICS
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-622-5956
Provider Business Practice Location Address Fax Number:
575-622-4059
Provider Enumeration Date:
06/07/2008