| NPI | 1306108584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA ALEXANDER-COOK President 234-312-5873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2017-11-11 |