NPI | 1215214283 |
---|---|
Doing Business As | PROVIDENCE MEDICAL GROUP |
Entity Type | Organization |
Authorized Contact | CLARK P. CHRISTIANSON President 251-631-3574 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Enumeration Date | 2011-11-04 |
Last Update Date | 2012-09-13 |