| NPI | 1386265254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER V AULD Owner 239-208-6676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2020-05-02 |
| Last Update Date | 2020-05-02 |