| NPI | 1013047356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FEDERICO CARLOS DE MIRANDA Owner 479-452-8311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: AR C-5393) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |