| NPI | 1013347046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMAR ELAINE RICH-HALL Registered Agent / Bookkeeper 754-214-1177 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2013-11-12 |