| NPI | 1336570191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA SUTHERLAND Provider Enrollment 229-891-9131 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2023-07-28 |