NPI | 1588929004 |
---|---|
Entity Type | Organization |
Authorized Contact | SCHARAZARD LEE GRAY Physician/Owner 218-208-3668 |
Organization Subpart ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
Enumeration Date | 2012-07-10 |
Last Update Date | 2022-04-19 |