Provider First Line Business Practice Location Address:
1 SAGEBRUSH RD.
Provider Second Line Business Practice Location Address:
ISLETA PUEBLO DIABETIC CLINIC
Provider Business Practice Location Address City Name:
ISLETA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-642-0578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2007