| NPI | 1174712897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REMEL BUSLIG Manager 870-864-0913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AR E-4509) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2007-10-18 |