| NPI | 1871799858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GEORGE LANG Owner 505-753-5811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 0318) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2020-08-22 |