Provider First Line Business Practice Location Address:
UNIVERSITY OF NEW MEXICO COEHP
Provider Second Line Business Practice Location Address:
FPC #232, 2400 TUCKER NE, MSC-10-5550
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:
505-272-8043
Provider Business Practice Location Address Fax Number:
505-272-8044
Provider Enumeration Date:
07/07/2008