Provider First Line Business Practice Location Address:
262 SOUTH 9TH STREET
Provider Second Line Business Practice Location Address:
ELEMENTARY SCHOOL BUILDING
Provider Business Practice Location Address City Name:
FORT SUMNER
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88119-9316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-355-7716
Provider Business Practice Location Address Fax Number:
575-355-6002
Provider Enumeration Date:
11/21/2017