Provider First Line Business Practice Location Address:
310 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCUMCARI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88401-2858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-288-9862
Provider Business Practice Location Address Fax Number:
575-244-9580
Provider Enumeration Date:
05/15/2026