Provider First Line Business Practice Location Address:
914 N. CANAL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-885-4836
Provider Business Practice Location Address Fax Number:
505-628-0676
Provider Enumeration Date:
01/28/2008