| NPI | 1346578861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE L WARNER Assistant Manager 547-957-3079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2009-12-17 |