| NPI | 1114483575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK GRAY Director 844-212-5321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 293D00000X Physiological Laboratory |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2020-06-09 |