Provider First Line Business Practice Location Address:
MSC09 5030
Provider Second Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
81731-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-8244
Provider Business Practice Location Address Fax Number:
505-272-4639
Provider Enumeration Date:
04/15/2022