| NPI | 1992457444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE JULISSA GANDIA-MORALES Administrator 386-406-2577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-04-29 |