Provider First Line Business Practice Location Address:
2400 TUCKER
Provider Second Line Business Practice Location Address:
FAMILY PRACTICE CENTER RM 232
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:
505-272-8043
Provider Business Practice Location Address Fax Number:
505-272-8044
Provider Enumeration Date:
12/01/2009