Provider First Line Business Practice Location Address:
1501 SAN PEDRO DR. SE
Provider Second Line Business Practice Location Address:
MEDICINE SERVICE (111)
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-265-1711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2019