| NPI | 1184956922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CORNELIUS LEATHERWOOD Owner 575-522-0091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM NM20060321) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2010-02-04 |