| NPI | 1801900451 |
|---|---|
| Doing Business As | FOUR CORNERS PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | DANIEL ROBERT RENUART President 863-424-8966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL me70353) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2011-10-19 |