| NPI | 1407047269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE MEDINA Owner 229-247-1667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: GA 041166) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2010-06-15 |