Provider First Line Business Practice Location Address:
2811 INDIAN SCHOOL RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-243-1158
Provider Business Practice Location Address Fax Number:
505-243-2115
Provider Enumeration Date:
11/21/2006