Provider First Line Business Practice Location Address:
1510 ELLISON RD NW
Provider Second Line Business Practice Location Address:
CIBOLA HIGH SCHOOL
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-897-0110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2006