Provider First Line Business Practice Location Address:
6030 1 UNIVERSITY OF NEW MEXICO
Provider Second Line Business Practice Location Address:
MSC 11
Provider Business Practice Location Address City Name:
ALBUQUEQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-4422
Provider Business Practice Location Address Fax Number:
505-272-0727
Provider Enumeration Date:
08/14/2007