| NPI | 1295802619 |
|---|---|
| Former Legal Business Name | MAIN STREET MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | DIANE M WEBER Owner 605-685-1450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 0304) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2008-10-01 |