| NPI | 1417379447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN SMITH Manager Of Regulatory Compliance 855-860-2109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 11865R) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2014-01-22 |