| NPI | 1205239589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ITZA D CHEVRES President 939-645-0504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 9462) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: PR 342726 corp register) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |