| NPI | 1518268283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICANOR C. LOPEZ Owner 267-475-8447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: FL 105419) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: PA MD037726L) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2010-11-11 |