| NPI | 1609318112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE M ARCHULETA Business Manager/CPO 505-450-1415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NM 000T6366) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2016-11-15 |