| NPI | 1295028686 |
|---|---|
| Former Legal Business Name | 4040I PRO HEALTH |
| Entity Type | Organization |
| Authorized Contact | JOSE GONZALEZ CEO 877-814-4040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 172A00000X Driver |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-05-18 |