| NPI | 1003535469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY KOGAN Executive Director 888-202-6052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-12-14 |