| NPI | 1871897058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAPHAEL FAJARDO GUANZON Owner 757-399-0513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101026720) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2011-01-03 |