| NPI | 1235666249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY RAYBURN Owner 505-310-5698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0100911) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-05-22 |