| NPI | 1023573805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTANY GREEN Owner 844-258-8747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2024-06-05 |