| NPI | 1316738560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL LANCE MARGOLIN Owner 551-804-7243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |