| NPI | 1083607352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | T GLEN BOUDER Director/Active,Attending 747-851-6151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: PA MD051542L) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2009-04-20 |