| NPI | 1639628316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE ARLEN MARKBREITER General Partner 848-208-2748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2016-09-23 |