| NPI | 1821020363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAZEL ILENE JACKSON Practice Manager 505-327-4429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-04-14 |