| NPI | 1932583820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MADRID Asst. Program Coord 575-571-2214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ RS2015-0499) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |