Provider First Line Business Practice Location Address:
3410 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:
87106-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-265-7817
Provider Business Practice Location Address Fax Number:
505-266-1543
Provider Enumeration Date:
07/05/2005