Provider First Line Business Practice Location Address:
1410 N. 8TH ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-941-2500
Provider Business Practice Location Address Fax Number:
575-941-2503
Provider Enumeration Date:
10/24/2007