Provider First Line Business Practice Location Address:
MSC 09 5230 HSSB # 204B
Provider Second Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Practice Location Address City Name:
ALBUQUERQUE
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:
505-272-6850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2011