NPI | 1356509061 |
---|---|
Entity Type | Organization |
Authorized Contact | MELANIE L MICK Medical Credentialing Consultant 234-855-6458 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
Enumeration Date | 2008-05-29 |
Last Update Date | 2013-06-05 |