| NPI | 1851572895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXABDER KRISHTUL Medical Director 866-366-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 237383-1) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2007-11-19 |