| NPI | 1912177577 |
|---|---|
| Other Name | VICENCIO ANTONIO III |
| Entity Type | Organization |
| Authorized Contact | ANTONIO SISON VICENCIO Sole Proprietor 386-586-3466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2008-09-10 |