| NPI | 1023878915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAE BERGH Manager 605-553-6458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-19 |