| NPI | 1336988005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIA DANETTE BILLSTONE-SIMPSON CEO 575-915-4230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-05-22 |