| NPI | 1801926647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN DEAN COLE Managing Physician 019-682-1425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: OK 3158) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-08-22 |