| NPI | 1265202105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY BLAKE Owner 765-623-6226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-11-14 |