| NPI | 1154895878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WATT Partner 772-218-0977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2019-01-16 |