| NPI | 1063987899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVA MARSH Medical Director/Owner 442-800-5300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2024-01-04 |