| NPI | 1740570886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ANTHONY CHAVARRIA Medical Doctor 267-265-4423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD044909E) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |