| NPI | 1477995173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLADYS LIZZETTE ANDRADE Owner 305-505-0460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 305R00000X) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-07-23 |