| NPI | 1609076504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M MACIAS President 505-984-8206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NM 76-228) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-20 |