Provider First Line Business Practice Location Address:
1100 CENTRAL AVE SE
Provider Second Line Business Practice Location Address:
PHS - LAB - S1
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-340-8390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2008