Provider First Line Business Practice Location Address:
MSC 09 5040
Provider Second Line Business Practice Location Address:
I UNIVERSITY OF NEW MEXICO (FPC)
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-1671
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2010