Provider First Line Business Practice Location Address:
1010 SPRUCE ST
Provider Second Line Business Practice Location Address:
LOCUM TENENS
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-367-0361
Provider Business Practice Location Address Fax Number:
505-367-0320
Provider Enumeration Date:
07/16/2008