| NPI | 1720304900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL MARIE TAPIA Social Worker 575-520-0887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: NM M-07165) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2010-04-13 |