Provider First Line Business Practice Location Address:
MSC 10 5560
Provider Second Line Business Practice Location Address:
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:
87131-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-5062
Provider Business Practice Location Address Fax Number:
505-272-6503
Provider Enumeration Date:
03/22/2012