| NPI | 1891177655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN LOPEZ Director 915-858-1076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0904X Clinic/Center, Public Health, Federal |
| Additional Taxonomies | 251S00000X (Licence: TX 1603-1603A) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-02-07 |