Provider First Line Business Practice Location Address:
318 ABALONE LOOP
Provider Second Line Business Practice Location Address:
MESCALERO LUDIAN HOSPITAL
Provider Business Practice Location Address City Name:
MESCALERO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88340-0210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-464-4441
Provider Business Practice Location Address Fax Number:
505-464-4422
Provider Enumeration Date:
09/21/2006