Provider First Line Business Practice Location Address:
325 S 1ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCUMCARI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88401-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-282-2222
Provider Business Practice Location Address Fax Number:
575-282-2224
Provider Enumeration Date:
06/28/2008