| NPI | 1396033080 |
|---|---|
| Doing Business As | 125TH STREET MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | IGOR NIZNIK Owner 786-235-7240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL hcc8934) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2011-07-14 |