Provider First Line Business Practice Location Address:
9426 INIDIAN SCHOOL RD NE
Provider Second Line Business Practice Location Address:
SUITE 2 SCOTT BLACKWELL PHD
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-342-0400
Provider Business Practice Location Address Fax Number:
505-342-0500
Provider Enumeration Date:
03/22/2006