| NPI | 1548472830 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | ALI M GHAFFARI Medical Director 505-762-6492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2016-10-26 |