| NPI | 1568769933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA VIGIL Billing & Rece PT Ion 505-988-5120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM 2000-129) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2012-06-18 |