| NPI | 1962663153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH DYE CEO 505-873-7401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2024-11-01 |