Provider First Line Business Practice Location Address:
1422 PASEO DE PERALTA
Provider Second Line Business Practice Location Address:
PHARMACY SERVICES UNIT
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87501-4391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-988-3876
Provider Business Practice Location Address Fax Number:
505-986-9959
Provider Enumeration Date:
07/18/2006