| NPI | 1457281214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT SLACK Owner 385-455-7170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2026-05-21 |
| Last Update Date | 2026-05-21 |