| NPI | 1053716902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA DEE MARTIN Owner/Provider 907-953-7949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 1103) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |