| NPI | 1164753687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHIE L WATSON-GRAY Owner 888-756-4224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2023-07-23 |