| NPI | 1104230622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE HANSEN Director, Clinical Ops & Perf 888-663-6331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-10-06 |