Provider First Line Business Practice Location Address:
101 HOSPITAL LP NE
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
ALBUQ
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-883-6600
Provider Business Practice Location Address Fax Number:
505-883-0023
Provider Enumeration Date:
06/06/2006