| NPI | 1083830608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN CANARIAS FUENTES Owner 580-223-5693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OK 13171) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 13171) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-01-30 |