| NPI | 1508292624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY L SAMANIEGO Owner 505-967-9975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM I-07362) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2013-09-20 |