Organization
PMS/WNMMG GRANTS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLA MITCHELL (ADMINISTRATOR)
(505) 287-2950
Entity
Organization
Contact information
Practice address
1217 BONITA ST, GRANTS, NM 87020-2103
(505) 287-2950
Mailing address
1217 BONITA ST, GRANTS, NM 87020-2103
(505) 287-2950
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD2009-0779
NM
Other
Enumeration date
04/29/2010
Last updated
04/29/2010
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