| NPI | 1619488210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLADIMIR BATRIN Practice Administrator 857-452-6356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2025-06-12 |