| NPI | 1013673821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN BROWN Chief Administrative Officer 833-904-0620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2023-01-19 |