Provider First Line Business Practice Location Address:
1010 SPRUCE STREET
Provider Second Line Business Practice Location Address:
PRESBYTERIAN ESPANOLA HOSPITAL
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-367-0365
Provider Business Practice Location Address Fax Number:
505-367-0362
Provider Enumeration Date:
04/12/2010