| NPI | 1376784702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD EMERICK Owner 855-577-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL OS9746) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2016-02-08 |