| NPI | 1043437254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOIN HANA Owner 606-886-1173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-02-24 |