| NPI | 1235429150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW DANIEL JOHNSON President/Owner 575-625-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NM NM0544) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |