Provider First Line Business Practice Location Address:
2150 HWY 54 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-443-8133
Provider Business Practice Location Address Fax Number:
575-267-1747
Provider Enumeration Date:
09/02/2005