| NPI | 1417370131 |
|---|---|
| Former Legal Business Name | GSRCOA |
| Entity Type | Organization |
| Authorized Contact | ELIZABETH ANN OAKES Clinical Director 575-472-5383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: NM I-04593) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2014-01-31 |