| NPI | 1417370057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY O EJERE Owner 682-582-2989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2024-08-29 |