| NPI | 1891870051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL JUDE BACA Practice Manager Operator 505-661-9030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-08-22 |