Provider First Line Business Practice Location Address:
521 CAMINO RIO VISTA
Provider Second Line Business Practice Location Address:
NORTHERN NEW MEXICO HEALTH CARE 82ACR122
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-753-7576
Provider Business Practice Location Address Fax Number:
505-753-7676
Provider Enumeration Date:
04/25/2007