| NPI | 1942220553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA KETCHESON Owne/Practitioner 505-989-1704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NM R14892) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |