| NPI | 1689310948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE BULLOCK Owner 385-455-7170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2025-02-10 |