| NPI | 1760718514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM R WOZNIAK Owner 870-492-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2010-09-01 |