Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
261QP2300X |
| NPI Number | 1144338088 |
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| Entity | Organization | ||||||||
| Organization subpart 1 | Not specified | ||||||||
| Enumeration date | 08/29/2006 | ||||||||
| Last updated | 07/08/2007 - About 19 years ago | ||||||||
| Identifiers |
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