| NPI | 1487029278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY CALHOUN Chief Operations Officer 866-980-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 193400000X) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 207P00000X) |
| Enumeration Date | 2015-12-06 |
| Last Update Date | 2016-04-07 |