Provider First Line Business Practice Location Address:
1101 MEDICAL ARTS AVE NE # 3
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:
87102-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-242-0070
Provider Business Practice Location Address Fax Number:
505-242-0060
Provider Enumeration Date:
10/19/2007