| NPI | 1376387274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADONICA SHAW Manager 800-491-2142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-24 |