| NPI | 1861921389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARI JOHNSON Admin 267-292-5638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD032595E) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-07-21 |