Provider First Line Business Practice Location Address:
1302 E MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCUMCARI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-461-2200
Provider Business Practice Location Address Fax Number:
575-461-2213
Provider Enumeration Date:
09/12/2022