| NPI | 1922504364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON BOLING Operations Officer 124-839-7826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 303032) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-04-21 |