| NPI | 1710206370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEADRON T FINN Registered Agent 505-986-1723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0124591) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2010-05-21 |