| NPI | 1043573199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA LEIJUAN LANE-FISHER Physician/Owner 769-257-5336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |