| NPI | 1528112109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY H MCMILLAN Owner 575-521-3025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NM 2470) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2013-05-14 |