| NPI | 1356780597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN R MINER Owner 505-463-9764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NM 1754) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2013-06-20 |