Provider First Line Business Practice Location Address:
CORNER OF STEWART AND BRELAND
Provider Second Line Business Practice Location Address:
STUDENT HEALTH CENTER, BOX 30001 MSC 3529
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-646-8308
Provider Business Practice Location Address Fax Number:
505-646-6428
Provider Enumeration Date:
08/23/2006