| NPI | 1336348135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN POE Owner 505-334-2852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NM A-834-86) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2008-05-20 |