| NPI | 1871173005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA SUSSEX-GRANT Registered Agent/Manager 505-325-2604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2021-04-12 |