Provider First Line Business Practice Location Address:
101 OCEAN BLVD
Provider Second Line Business Practice Location Address:
MOGUL MEDICAL URGENT CARE
Provider Business Practice Location Address City Name:
TAOS SKI VALLEY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87525-0067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-776-8421
Provider Business Practice Location Address Fax Number:
575-776-8942
Provider Enumeration Date:
04/27/2006