| 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 |