Individual
PHILIP EAN FORREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 W 2ND ST, PORTALES, NM 88130-6232
(575) 356-2222
Mailing address
1904 S GLOBE AVE, PORTALES, NM 88130-7374
(575) 693-1140
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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