| NPI | 1598448854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINNY RENEAU Business Administrator 315-956-0935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RB0002X Internal Medicine, Bariatric Medicine |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |