| NPI | 1780142042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED LEE WALLACE Owner 907-313-4569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2020-02-05 |