| NPI | 1851113120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE GONZALEZ Owner 877-866-7123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2025-01-10 |