| NPI | 1538772173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN LYNN NINEFELDT Owner 907-201-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QR1300X Clinic/Center Rural Health |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2020-08-24 |