| NPI | 1407304017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER K MALCOLM President 907-456-3341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AK 10040231) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-13 |