| NPI | 1366817512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISTAIR CO Owner 810-406-7175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME110427) |
| Enumeration Date | 2015-12-13 |
| Last Update Date | 2015-12-13 |