Provider First Line Business Practice Location Address:
135 MADISON ST NE
Provider Second Line Business Practice Location Address:
MTN RIVER MUSCULAR THERAPY
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-321-3219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2013