Provider First Line Business Practice Location Address:
ACL PHS INDIAN HOSPITAL
Provider Second Line Business Practice Location Address:
I - 40 EXIT 102
Provider Business Practice Location Address City Name:
SAN FIDEL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-552-5354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2008