| NPI | 1750773123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN CARLSON Owner 505-250-3047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0167751) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2015-02-23 |