| NPI | 1720324502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIYA IVANOVA MANOVA President 501-773-1233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 060.009921) |
| Enumeration Date | 2012-12-23 |
| Last Update Date | 2012-12-23 |