| NPI | 1669551446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE COSTALES Billing Specialist 505-888-0035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM 82161) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2012-10-23 |