| NPI | 1720393937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ASHLEY WILSON Sole Member 808-744-1906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS 1154) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2010-08-11 |