Provider First Line Business Practice Location Address:
519 NORTH 10TH. STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SUMNER
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-355-8811
Provider Business Practice Location Address Fax Number:
575-355-8810
Provider Enumeration Date:
12/17/2008