Provider First Line Business Practice Location Address:
202 W CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-885-2165
Provider Business Practice Location Address Fax Number:
575-887-8300
Provider Enumeration Date:
06/01/2006