| NPI | 1013589845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANI GERENIA Owner 774-314-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |