Provider First Line Business Practice Location Address: 
1 UNIVERSITY OF NEW MEXICO MSC10 5590
    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: 
87131-3983
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
505-272-2345
    Provider Business Practice Location Address Fax Number: 
505-272-2374
    Provider Enumeration Date: 
04/10/2020