| NPI | 1982974820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN WRIGHT Controller 980-200-4259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |