Individual
MRS. LORI LYNN MOOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1258 LEA RANCH DR., LAS CRUCES, NM 88012
(505) 373-0850
Mailing address
1258 LEA RANCH DR., LAS CRUCES, NM 88012
(505) 373-0850
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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