| NPI | 1720118037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE GABBANAJAN Office Manager 242-353-4777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI MJ034283) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-02-28 |