| NPI | 1366949398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY DEAN FERNANDEZ Owner 505-320-2183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM I-04850) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |