| NPI | 1013388651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA A WAHL Business Operations Director 667-239-3205 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |