Provider First Line Business Practice Location Address:
13701 ENCANTADO RD NE
Provider Second Line Business Practice Location Address:
ATTN: PHARMACY
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87123-2275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-727-5945
Provider Business Practice Location Address Fax Number:
505-727-9072
Provider Enumeration Date:
09/17/2009