| NPI | 1982944245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA JEAN GANSHAW Owner 505-480-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NM DH3281) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2013-02-25 |