Provider First Line Business Practice Location Address:
2450 SOUTH TELSHOR
Provider Second Line Business Practice Location Address:
MEMORIAL MEDICAL HOSPITAL
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-7594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-621-0800
Provider Business Practice Location Address Fax Number:
575-373-3091
Provider Enumeration Date:
12/08/2010