| NPI | 1780067876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY CARR RANDALL President 505-401-1188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NM 1045) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |