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Organization
1150 MAIN STREET INC
NPI 1912347261
Active
Family Medicine
Quick Facts
NPI Number
1912347261
Type
Organization (NPI-2)
Status
Active
Enumeration Date
2013-07-01
Last Updated (NPPES)
2013-07-01
Primary Specialty / Taxonomy
| Taxonomy | Family Medicine |
| Taxonomy Code | 207Q00000X |
| License | G56281 CA |
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