| NPI | 1639491616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2025-03-13 |