| NPI | 1952629347 |
|---|---|
| Doing Business As | MEMORIAL PHYSICIAN NETWORK - SENIOR CLINIC |
| Entity Type | Organization |
| Authorized Contact | MARY JO YANTIS Vice President 719-365-9951 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2010-06-18 |