| NPI | 1912671090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI SOULE CEO 772-257-8224 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207VG0400X Obstetrics & Gynecology, Gynecology | |
| 208000000X Pediatrics | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2022-03-22 |