Provider First Line Business Practice Location Address:
I40 EXIT 102 HALF MI SOUTH
Provider Second Line Business Practice Location Address:
ACL HOSPITAL DENTAL CLINIC
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:
505-552-5310
Provider Business Practice Location Address Fax Number:
505-552-5460
Provider Enumeration Date:
01/05/2007