| NPI | 1750975082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENESIS MORENO Owner / President 239-771-0583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-02-26 |