NPI | 1467813295 |
---|---|
Entity Type | Organization |
Authorized Contact | KRISTEN LUM Owner 505-917-9292 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA AC17604) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NM 1185) |
Enumeration Date | 2016-03-07 |
Last Update Date | 2017-11-02 |