| NPI | 1942543988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR SANTIAGO RODAS E2/Ha 631-745-7381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1103X Clinic/Center Military Ambulatory Procedure Visits Operational (Transportable) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2013-03-28 |