| NPI | 1154112688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MODESTO RODRIGUEZ President 645-223-3136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-05-14 |