| NPI | 1114149234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST PAUL DE LEON Owner 386-758-6141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL 0061518) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |