| NPI | 1073138244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT DANIEL BURGNER Director 505-726-7642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2024-10-14 |