| NPI | 1366950776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND JIMENEZ Managing Director 178-687-0403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2018-03-27 |