| NPI | 1215137963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY ALAN HANSON President 048-295-2257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA C33389) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2007-11-14 |