Provider First Line Business Practice Location Address:
1101 MEDICAL ARTS, N.E.
Provider Second Line Business Practice Location Address:
BLDG. 4 - SUITE A
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-2273
Provider Business Practice Location Address Fax Number:
505-272-2075
Provider Enumeration Date:
09/06/2012