| NPI | 1104803675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE GIAQUINTO Director 505-662-1419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: NM 200110082) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2009-03-25 |