| NPI | 1386013423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRUCILLA SUSAN WHELAN Owner 347-439-0472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: MT MED-LIC-ACU-144) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2015-09-18 |