Provider First Line Business Practice Location Address:
MANULITO STREET BUILDING T006-013
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
TOHATCHI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-733-2825
Provider Business Practice Location Address Fax Number:
505-733-2829
Provider Enumeration Date:
05/24/2007