Provider First Line Business Practice Location Address:
3830 N GRIMES ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HOBBS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88240-1279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-392-3971
Provider Business Practice Location Address Fax Number:
575-392-4169
Provider Enumeration Date:
10/03/2005