Provider First Line Business Practice Location Address:
1015 E ROOSEVELT AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
GRANTS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87020-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-251-1132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006