| NPI | 1013561992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON KNOX President 888-995-0455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261Q00000X |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2021-04-22 |