| NPI | 1922551308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH KING Owner 844-882-3127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 122300000X Dentist |
| 152W00000X Optometrist | |
| 231H00000X Audiologist | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2018-05-10 |