| NPI | 1780945634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MILLER SMITH President 267-970-7117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD431430) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD427776) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2017-02-24 |