| NPI | 1275907867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C BOURLAND CEO 6149-398-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |