Provider First Line Business Practice Location Address:
1101 MEDICAL ARTS AVE NE, BUILDING 4, SUITE A
Provider Second Line Business Practice Location Address:
UNM LOBO CARE
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-3935
Provider Business Practice Location Address Fax Number:
505-951-4006
Provider Enumeration Date:
10/03/2006