| NPI | 1942483896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA ESTALILLA-QUIZ Owner/President 765-720-7085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IN 71002412A) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2008-05-14 |