| NPI | 1750977237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ADER Practice Administrator 385-432-3240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2023-11-07 |