| NPI | 1013680503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE HALL Owner/Authorized Official 855-743-2247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2021-08-03 |