| NPI | 1225308885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY RENEE HAZEN Owner 575-935-5560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NM 1939) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-07-02 |