NPI | 1669619441 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK DAVID RICHARDSON Owner 269-781-3938 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301047635) |
Enumeration Date | 2009-01-15 |
Last Update Date | 2010-06-10 |