| NPI | 1114269313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON PENDERGRASS Billing Manager 907-355-0850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 955730) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2013-03-26 |