| NPI | 1578399747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SATISH V RAVI Director 386-328-6746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2024-09-15 |