Provider First Line Business Practice Location Address:
15136 ST. RD. 75
Provider Second Line Business Practice Location Address:
EL CENTRO FAMILY HEALTH PENASCO DENTAL CLINIC
Provider Business Practice Location Address City Name:
PENASCO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87553-0516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-587-2809
Provider Business Practice Location Address Fax Number:
575-587-2605
Provider Enumeration Date:
12/30/2014