NPI | 1427216993 |
---|---|
Entity Type | Organization |
Authorized Contact | GERALD GRIFFITH Physician Assistant 920-743-5566 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: GA 1593) |
Enumeration Date | 2008-05-30 |
Last Update Date | 2008-05-30 |