| NPI | 1356876890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISVEL ALEXANDRA MATOS Physician Extender 980-314-9073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |