| NPI | 1740592054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS E. SWISSTACK Director 505-468-7122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 9628) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM 97PA03) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2010-07-02 |