Provider First Line Business Practice Location Address:
MSC10 5530 1 UNIVERSITY OF NEW MEXICO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-2269
Provider Business Practice Location Address Fax Number:
505-272-5821
Provider Enumeration Date:
03/25/2022