| NPI | 1396851804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA M JASKIC Executive Director 906-228-3613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2008-05-14 |