| NPI | 1871973297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGIL MEDINA CEO 575-526-1105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2017-05-25 |