| NPI | 1518067446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY FREDERICK MOSLEY Contract Manager 505-325-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |