| NPI | 1649304395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS ESTANISLAO LUCERO Owner 304-255-7456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: WV 10355) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2008-08-12 |