Provider First Line Business Practice Location Address:
1010 SPRUCE STREET
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-288-0673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2019