| NPI | 1740286863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGIL MEDINA Cheif Executive Officer 575-526-1105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2021-05-13 |