| NPI | 1700325610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIJUAN WANG Physician 731-221-6870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2024-11-07 |