| NPI | 1508900622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUILLERMO ISMAEL ROCHA Owner 210-922-5922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX G6382) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-10-01 |