Provider First Line Business Practice Location Address:
2559 MEDICAL DRIVE, SUITE D
Provider Second Line Business Practice Location Address:
GERALD CHAMPION REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-434-2220
Provider Business Practice Location Address Fax Number:
575-439-5705
Provider Enumeration Date:
09/22/2006