| NPI | 1396591202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIE WEHUNT Administrator 888-633-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-04-30 |