Provider First Line Business Practice Location Address:
325 S 1ST 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:
88401-2707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-461-2222
Provider Business Practice Location Address Fax Number:
575-461-2255
Provider Enumeration Date:
02/28/2008