| NPI | 1740559855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENAE HOSKIN Administrator 386-615-1521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2024-05-02 |