| NPI | 1306245246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEREDITH M WALLIS Owner 505-681-7769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AK 1003461) |
| Enumeration Date | 2014-08-16 |
| Last Update Date | 2014-08-16 |