| NPI | 1497021257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATY LOUISE WAMEL-PETERMEIER Owner 575-496-5551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NM 03239181001) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-03-27 |