Provider First Line Business Practice Location Address:
LOBO CANYON RD
Provider Second Line Business Practice Location Address:
WESTERN NEW MEXICO CORRECTIONS
Provider Business Practice Location Address City Name:
GRANTS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87020-0250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-876-8360
Provider Business Practice Location Address Fax Number:
505-876-8357
Provider Enumeration Date:
09/25/2007