NPI | 1760643670 |
---|---|
Entity Type | Organization |
Authorized Contact | GONZALO IVAR HIDALGO Owner/Physician 318-443-0490 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 025214) |
Enumeration Date | 2008-06-23 |
Last Update Date | 2008-06-23 |