NPI | 1912383001 |
---|---|
Entity Type | Organization |
Authorized Contact | UNKNOWN PERSON Dont Know 575-445-5563 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NM 96-165) |
Enumeration Date | 2015-07-31 |
Last Update Date | 2019-06-26 |