| NPI | 1245362508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | W JOSEPH GORUM Pres 340-643-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: VI 1366) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-08-22 |