| NPI | 1104338490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YAZID ATIEH Owner/Pharmacist Clinician 575-915-1538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: NM 16402) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NM 16402) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |