| NPI | 1295127025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALENA SMITH Administrator 866-823-0884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD000025847) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2015-03-03 |