| NPI | 1760415137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELVIRA FABIOLA LOMBARDO Hs3 231-922-8282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WI 45189021) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2020-08-22 |