Provider First Line Business Practice Location Address:
DEPARTMENT OF IM MSC10 5550
Provider Second Line Business Practice Location Address:
UNMHSC 1 UNIVERSITY OF NM
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:
505-272-4868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2009