| NPI | 1770766768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MANGUM Director Physician Services 505-521-5277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |