| NPI | 1386888162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN SANTANA President 800-969-4965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL 569338-8) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2009-04-24 |