| NPI | 1114144888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELO POLANCO Owner 337-684-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: LA LA023828) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2011-06-21 |