Provider First Line Business Practice Location Address:
185 DR. MICHAEL JENKINS ROAD
Provider Second Line Business Practice Location Address:
CMS MEDICAL UNIT
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-374-4005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006