Provider First Line Business Practice Location Address:
MSC08 4640
Provider Second Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
81731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-4814
Provider Business Practice Location Address Fax Number:
505-271-0240
Provider Enumeration Date:
05/01/2025