Provider First Line Business Practice Location Address:
1212 9TH STREET
Provider Second Line Business Practice Location Address:
SUITE H TULAROSA BASIN DERMATOLOGY
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:
505-437-6700
Provider Business Practice Location Address Fax Number:
505-437-6644
Provider Enumeration Date:
09/20/2006