Provider First Line Business Practice Location Address:
NNMC
Provider Second Line Business Practice Location Address:
491 US HIGHWAY 64W
Provider Business Practice Location Address City Name:
SHIPROCK
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87420-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-368-7305
Provider Business Practice Location Address Fax Number:
505-368-7319
Provider Enumeration Date:
04/17/2007