| NPI | 1386161354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HESTER BALSAM Owner 505-899-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: NM I-05220) |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2017-08-29 |