| NPI | 1053739375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY JONES Regional Business Manager 980-721-2675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2014-04-03 |