| NPI | 1689941932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIO AUGUSTO GOMEZ Family Practice/Owner 260-444-5695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01056928A) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2012-07-16 |