| NPI | 1023625662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL KENNETH BRANCH Owner 866-477-1169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2023-09-14 |