Provider First Line Business Practice Location Address:
101 HOSPITAL LP NE
Provider Second Line Business Practice Location Address:
STE 211
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-888-1678
Provider Business Practice Location Address Fax Number:
505-888-7684
Provider Enumeration Date:
04/24/2006