| NPI | 1104996776 |
|---|---|
| Doing Business As | WAN'S MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | RICHARD TC WAN Owner 270-526-3841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KY 16599) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2008-06-18 |