| NPI | 1598058232 |
|---|---|
| Doing Business As | OVER THE EDGE |
| Entity Type | Organization |
| Authorized Contact | AUTRELL SHERROD BROWN Owner/CEO 505-463-6328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2011-05-26 |