Provider First Line Business Practice Location Address:
KEWA PUEBLO HEALTH CORPORATION
Provider Second Line Business Practice Location Address:
85 W HWY 22
Provider Business Practice Location Address City Name:
SANTO DOMINGO PUEBLO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-465-3060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2006