Provider First Line Business Practice Location Address:
2539 MEDICAL DR
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-434-1353
Provider Business Practice Location Address Fax Number:
505-434-1398
Provider Enumeration Date:
02/24/2006