| NPI | 1740571645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SLYVIA MCCORMICK Member 907-374-8914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2011-04-26 |