| NPI | 1730452970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS L DOMINGUEZ Owner/President 386-789-8544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0072352) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2012-02-20 |