| NPI | 1083189724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY JOSEPH BIJAK Manager 505-270-3823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2020-12-23 |