| NPI | 1750688032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN J GOODLUCK President 505-792-2636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NM 97251) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2011-10-19 |