Provider First Line Business Practice Location Address:
608-B LA JOYA ST
Provider Second Line Business Practice Location Address:
EL CENTRO FAMILY HEALTH ESPANOLA DENTAL
Provider Business Practice Location Address City Name:
ESPANOLA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87532-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-753-9454
Provider Business Practice Location Address Fax Number:
505-753-0850
Provider Enumeration Date:
10/27/2011