| NPI | 1013540962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIDA ALI Owner 346-374-8402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2023-04-04 |