| NPI | 1639681786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA BRYANT Owner 786-203-2325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 289760-1) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2021-02-19 |