| NPI | 1679894190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY LOWE Owner 2565-546-4868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: AL MD28124) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2010-06-18 |