| NPI | 1124391768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBIE DELABARCENA Office Manager 505-326-0552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NM NM399) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2012-02-13 |