Provider First Line Business Practice Location Address:
407 W HIGHWAY 66
Provider Second Line Business Practice Location Address:
THE LEXINGTON HOTEL
Provider Business Practice Location Address City Name:
GALLUP
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87301-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-722-0066
Provider Business Practice Location Address Fax Number:
505-722-2329
Provider Enumeration Date:
11/14/2016