Provider First Line Business Practice Location Address:
MSC 3FAC NEW MEXICO STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
P P BOX 30001
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88003-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-646-1526
Provider Business Practice Location Address Fax Number:
505-646-3435
Provider Enumeration Date:
02/15/2007