| NPI | 1073049367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAE LUECK CEO 747-273-6179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-01-28 |