| NPI | 1003051210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER SCOTT BRACKMAN Pa 910-988-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient (Licence: NC 0010-01314) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2008-12-03 |