| NPI | 1033489216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TESFAYE DEMISSIE FANTA Owner 336-342-9564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NC 200900231) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |