| NPI | 1063425486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BOLAND Owner 662-240-1412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2008-07-05 |