Provider First Line Business Practice Location Address:
524 DEMOSS ST.
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
LORDSBURG
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88045-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-542-3949
Provider Business Practice Location Address Fax Number:
575-542-3949
Provider Enumeration Date:
08/04/2009