| NPI | 1881974194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANAKA LAKSHMY CHELLAH Provider 575-652-4048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD20100227) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2017-05-05 |