Provider First Line Business Practice Location Address:
CORNER OF UNIVERSITY & JORDAN
Provider Second Line Business Practice Location Address:
SPEECH BUILDING ROOM 158
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88003-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-646-7987
Provider Business Practice Location Address Fax Number:
505-646-3140
Provider Enumeration Date:
05/16/2007