| NPI | 1003192956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILANA CORNELIUS Family Nurse Practitioner 575-437-1113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NM R21461) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2012-03-26 |