Provider First Line Business Practice Location Address:
800 EAST NINTH AVENUE
Provider Second Line Business Practice Location Address:
SIERRA VISTA COUNSELING CENTER
Provider Business Practice Location Address City Name:
TRUTH OR CONSEQUENCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-743-1380
Provider Business Practice Location Address Fax Number:
575-743-1362
Provider Enumeration Date:
04/21/2014