| NPI | 1285351759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEITHA CHARMAINE BURTON Revenue Cycle Manager 505-539-5290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2022-10-25 |