| NPI | 1750610499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL TUCKER President 505-440-9545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2019-12-17 |