| NPI | 1174540017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REVA A RICHARDSON Manager 340-776-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2011-10-26 |