Provider First Line Business Practice Location Address:
FAMILY MEDICINE- LOGAN
Provider Second Line Business Practice Location Address:
600 GALLEGOS ST
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-487-9000
Provider Business Practice Location Address Fax Number:
575-487-9002
Provider Enumeration Date:
11/05/2007