| NPI | 1770843070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORE PEASE CEO 505-753-7218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2023-06-07 |