Provider First Line Business Practice Location Address:
332 E MOTEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORDSBURG
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88045-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-542-3304
Provider Business Practice Location Address Fax Number:
575-534-1150
Provider Enumeration Date:
06/17/2013