Provider First Line Business Practice Location Address:
MSC10 5550 1 UNIVERSITY OF NEW MEXICO
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:
87131-3983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-6331
Provider Business Practice Location Address Fax Number:
505-272-0475
Provider Enumeration Date:
04/01/2019