| NPI | 1477836278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM COLE Medical Director 800-875-0136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2012-09-20 |