| NPI | 1780948885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HERMAN WIDNER Director 505-224-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 01333671) |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2024-03-01 |