| NPI | 1467721183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE R MOORE Chief Administrative Officer 857-331-6271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine | |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2025-07-09 |