| NPI | 1033247176 |
|---|---|
| Doing Business As | MAIN STREET MEDICAL |
| Entity Type | Organization |
| Authorized Contact | PETER KONG GO Physician 870-222-3644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AR R3053) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |