Provider First Line Business Practice Location Address:
106 BLANCA AVE.
Provider Second Line Business Practice Location Address:
SAN LUIS VALLEY REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
ALAMOSA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-589-2511
Provider Business Practice Location Address Fax Number:
719-589-1372
Provider Enumeration Date:
09/19/2007