Individual
MARY L GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
454 LIPAN AVE, MESCALERO, NM 88340
(575) 464-4802
Mailing address
454 LIPAN AVE, MESCALERO, NM 88340
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-280
NM
Other
Enumeration date
04/18/2013
Last updated
04/18/2013
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