| NPI | 1457680357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA NELSON Credentialing Coordinator 906-233-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2018-01-11 |