| NPI | 1578110011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | METTESSA MAYE REID Administrator 907-250-3482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2019-08-20 |