Provider First Line Business Practice Location Address:
MSC08 4700 01 UNIVERSITY OF NEW MEXICO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-3414
Provider Business Practice Location Address Fax Number:
505-272-8239
Provider Enumeration Date:
12/08/2020