Provider First Line Business Practice Location Address:
1600 JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-234-3312
Provider Business Practice Location Address Fax Number:
575-234-3561
Provider Enumeration Date:
03/07/2011