| NPI | 1588240782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KIRK President 547-768-0082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2024-02-27 |