| NPI | 1043661010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE A LAFOND Coordinator Provider Enrollment 505-272-8950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-06-30 |