Individual
MR. RUSSELL LEE LILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8801 HORIZON BLVD NE, SUITE 260, ALBUQUERQUE, NM 87113-1533
(505) 798-5704
(505) 798-5682
Mailing address
8801 HORIZON BLVD NE, SUITE 260, ALBUQUERQUE, NM 87113-1533
(505) 798-5704
(505) 798-5682
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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