| NPI | 1902315161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY SHULMAN Manager 800-750-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2017-09-20 |