| NPI | 1265789077 |
|---|---|
| Former Legal Business Name | THERESA KLIESEN |
| Entity Type | Organization |
| Authorized Contact | THERESA SUSAN KLIESEN-MARAVETZ Owner 505-489-1452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM 0101591) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2012-08-10 |