Provider First Line Business Practice Location Address:
606 NORTH 13TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-3565
Provider Business Practice Location Address Fax Number:
806-771-3560
Provider Enumeration Date:
06/01/2009