| NPI | 1386696193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARRON J LESLIE Owner 870-741-7616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-05-18 |